Pediatric bipolar disorder (BPD) is characterized by the early age of onset of mood disturbance; long duration; fluctuating course; high familial loading for mood and other psychiatric disorders; high rates of co-morbid psychiatric disorders particularly attention deficit/ hyperactivity disorder (
ADHD1, disruptive behavior, anxiety disorders, and psychosis; and prevailing mixed/ rapid cycling episodes (2,5,61 Early recognition and treatment of BPD in children and adolescents is important to ameliorate ongoing symptoms and to reduce or prevent serious psychosocial morbidity (6,7,81 In 74% of individuals with BPD, psychopathology is recognizable before age 3, usually as mood and sleep disturbances, hyperactivity, aggression, and anxiety but pediatric BPD is often mis-or undiagnosed (9)